Hi all,
Anal fissure sufferer for about 15 months total. Really brutal - 3 raging chronic fissures at once that developed due to chemotherapy and cancer treatments. I've posted the back-story under "CRS Says it's Healed - it's NOT" for further reading.
I can't believe I'm actually making the "I'm Healed" post as I never thought I'd get here. I have been struggling with this mentally and physically and nothing sucked the joy out of the last year more than this (and that's from someone who had a double mastectomy, reconstruction, lymph nodes out, 8 rounds of chemo, 18 rounds of immunotherapy, hospitalized 3 times... but I digress). Needless to say - it's the WORST and I totally get it. But mine were terrible and if I can heal - so can you! You will get there.
It's been 4 months since my Botox and I haven't had ANY pain or bleeding with bowel movements for the past 6 weeks. What worked for me was a combination of things but I didn't start really recovering until I tried the Botox (after I'd been suffering for about 10 months by that point).
I literally tried it all, including some of the following. Some worked and some didn't so I'll explain what was helpful below:
- Botox to sphincter - the most helpful
-Diltiazem/nitro - marginally helpful
- antibiotics 4 different times - not ultimately helpful
- manuka honey - not helpful
- miralax and stool softeners - very helpful
- various ointments: olive oil, ozone oil, coconut oil, cannabis oil, aloe vera, vitamin e, hydrocortisone, hemmorhoid creams, fissure cure essential oil blend, zinc oxide, witch hazel, calendula - not ultimately helpful
- lube up anus before each bowel movement - very helpful
- tea tree oil - very helpful
- preparation H wipes - helpful for when travelling or not able to BM at home (always in my purse)
- squatty potty - so very helpful (wish I ordered one sooner)
- vegetarian diet and different diets - ultimately not helpful
- heating pad - very helpful
- sitz bath with salts after each BM - very helpful
- support for my anxiety around fissures - very helpful
- this forum - honestly was very helpful and very detrimental at times, I'll explain
Okay so what I'll do now is explain in more detail the items that I'd class as "VERY HELPFUL"
1) Botox: first and foremost, your sphincter needs to be relaxed to heal. I waited so long on the Botox because of horror stories in this forum or people saying it didn't work. My colorectal surgeon and I had 4 different appointments 2 weeks apart each time where he would tell me it was so effective and to stop reading the forum stories but I couldn't help it - I lived on here for those months. When I finally listened to him, it was the best decision ever! The botox barely hurt at all, there was NO pain afterwards and the bowel movement was pretty much the same as it had been pre-botox for the first week or so and then after 10 days I started noticing progress. I was so scared but the procedure was done in all of 2 minutes and I walked outta there and drove home and went on with my day. Truly wish I did it upfront!
A few Botox tips:
1) I didn't start healing until 10 WEEKS! You read that right, 10 weeks. I was sure it failed. I went back to my CRS bawling and told him it didn't work. He told me to calm down and be patient. Sure enough, it took 4 full months to get to where I'm at in the healing journey. It definitely didn't work right away.
2) As the fissure heals, it's very common to notice pus or discharge oozing from the fissure. This only happened with 1 of my 3 fissures, the deepest one. It freaked me out when I saw it and I kept meticulously cleaning it away. Once I stopped doing this and just let nature run it's course, the healing was expedited from there. What I realized is that the sphincter was so tight that infection was being trapped inside there by the tight-clenched muscle. Antibiotics would work temporarily but then a few weeks later, the pain would return in that fissure because the stool would be re-trapped. Once the Botox had relaxed the fissure, my body was able to naturally clean away the infection and get to work on healing.
3) In light of the above, Botox works for the relaxation part but you need to take steps to keep the area clean. Which brings me to the next part:
2) Sitz Baths and Tea Tree Oil:
In the beginning, I would wipe with a wet cloth, use a spray bidet attachment OR a peri-bottle when I was away to clear away any feces residue, sit in a salt Sitz bath for 20 minutes and then I'd apply whatever ointment I was desperately trying that month and be done. I literally did this after EVERY bowel movement. And twice, my lateral fissure still got infected and I ended up on antibiotics or in the Emergency Room. I was able to tell it was infected only because of the fact that it extends out of the sphincter by a centimetre but for those of you that are entirely internal it makes me wonder: how many of you are going through periods of infection and not knowing it? The pain of infection is very similar to the spasm pain except it ONLY hurts in the fissure itself (i.e. it's very localized, not felt all over) so it's very hard to tell the difference. The game changer for me was the Botox as I said, but also adding this to my process: hopping in the shower after a BM and very gently soaping up my anus with Hypoallergenic baby soap. I would then apply vaseline and ONE DROP of tea tree oil for extra bacteria-fighting effects. I've noticed some people use Polysporin, others go natural with coconut oil - whatever works. The point is, the fissure needs to be kept clean to heal or your body is wasting precious healing resources between bowel movements removing the stool and bacteria instead of regenerating the tissue or worse - trapping infection in there like in my case! Help your body along by getting an air-tight cleaning routine.
3) Squatty Potty:
GET A SQUATTY POTTY! I waited way too long to take this advice and didn’t get the squatty potty until I’d already been suffering for 11 months. Once I got the squatty potty, I found I was keeping my BMs to one per day more routinely! The squatty potty helped totally clear my colon so that there was no un-evacuated stool that would cause me to go later in the day. I wish I had listened to the advice and ordered one sooner; they are like $20 on amazon and worth it. I’ll use it forever.
4) Lubing up anus before going #2 and stool softeners:
This is easy - you need to avoid retears. I use vaseline before each BM and take a Colace + half cup of Miralax every night. I talked to my CRS this past week and told him how well I'm doing, that I don't even feel like I had fissures anymore. And he told me to stay on the stool softeners for 2 more months! A re-tear can ruin all your progress. Not worth it! :)
5) Getting my anxiety around fissures under control:
Honestly, I had to talk to my doctor about this and get some meds + a therapist because the condition was so debilitating to my quality of life - I was severely anxious/depressed and on the worst pain/spasm days I didn't want to go on. One of the issues is that I was obsessive-compulsively checking my fissures with a hand mirror multiple times every day. This is not helpful - I probably re-tore or damaged the fissure by constantly spreading my cheeks to look. Your body is not meant to expose your anus that constantly and so I stopped doing this and now go ONLY base on feel and allow my CRS to be the only one to look. That's why I say this forum was helpful and harmful for me personally... I think I read every single post that exists on the site here. Unfortunately along with the successes, this means I read every horror story, every failed procedure... it definitely got me way more worked up than I needed to be. I'm not blaming the forum because it also helped me SOOO much at times, but I would use it in moderation if you are a personality like mine and find yourself getting OBSESSED with healing like I was.
Anyways, I hope this post helps people out there. I know how horrible this condition can be but I promise you all - YOU WILL HEAL! It takes time and patience. Healing is truly a journey but you will get there and never look back!! :)
Wishing you all anal help.